Organization
COMMUNITY PHARMACY, LLC
Active
Other names
Fountain Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED GRAY (MANAGING MEMBER)
(405) 419-7716
Entity
Organization
Contact information
Practice address
3125 SW 89 ST, OKLAHOMA CITY, OK 73159
(405) 605-7700
(405) 605-7712
Mailing address
205 NW 63RD ST, SUITE 300, OKLAHOMA CITY, OK 73116-8254
(405) 419-7716
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1-5137
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3724754
NCPDP
OK
Enumeration date
02/08/2007
Last updated
08/22/2020
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